16 - Insanity from lack of minerals strikes!

My knee surgery was immense. 

As you can see from the above 3 dimensional snapshot that formed one of the many CT scans, the condyle of my thigh bone had broken free in the collision. It's splintered shape ran the risk of severing my main leg artery at any time during, after, or since the collision in hospital. This was the first task during surgery.

Second, the resetting of my knee bone (what was left of it) to its correct position was next on the list for the operation. It appears that the patella was shattered to almost nothing and the largest piece that remained had tried to heal itself to the end of my thigh bone. This had be cut free and then repositioned back to its original location.

Then, the placement of a large piece of titanium plating was added to my knee to help keep it all secured in place.

The knee plate viewed from the top, finishing mid thigh

(Looking at the 3D image, you can still clearly see the holes in the bone from the exterior fixator on my thigh that rant to my shin!)

"The operation lasted for hours"

The operation lasted for hours. My wife was getting somewhat aggitated in the waiting room of the ward, hoping all was proceeding well. After a long and agonising wait, I was brought back to the ward from the recovery room. 

My recovery from this operation was the worst. Under orders from the surgeon, I was to have, on my leg day and night, a CPM machine. This is a Continuous Passive Motion machine that bends the leg for you and can be preset to move to increase the speed and finishing angle. 

Image borrowed to highlight the machine used in my case

A similar functioning machine, like the one pictured above, I had to have working even when I slept to avoid my leg becoming static and ceasing to function properly. Or, as the surgeon put it, "I don't want your inability to walk to undo all of my good work!"

".. forced down your nose and into your stomach .."

My body reacted to this operation in another unforeseen way, however. For it was owing to the general anaesthetic and extended period I was under in theatre that shut my digestive system down. My bowels went on strike! 

I couldn't eat, nor drink, without being sick and, to really make my stay in hospital that more enjoyable, I had to have an NG tube. Again, for those not clear on medical practices, an NG (or Nasal Gastric) tube is a tube that is forced down your nose and into your stomach to drain its contents. As a consequence, I was only allowed sips of 60mm of water per hour to keep hydrated. Boy, was I lucky!

Another borrowed image to detail the NG

This went on for several days. I had to have regular blood tests to ensure my chemical balance was achieved but my veins receeded when these tests increased. It would have been easier to get blood from a stone than dip into my veins for a sample. 

Then, after an infection, I was moved to a single room on my own and that's where a chemical imbalance made me go loopier than a circus clown. You see, the body requires a delicate balance of minerals in order to function properly; sodium, potassium, magnesium and a whole host of others. My wife had arrived one day for visiting hours, only to be intercepted by the Sister of the ward who proceeded to tell her, "He's not himself today."

".. completely 'lost the plot'.."

Further investigation from her proved the Sister's comments to be right. I had completely 'lost the plot'. From my delusional perspective, I had died. For some reason, I had formulated some waking dream that I was needing to get to the next world by way of interstellar travel. I remember only two hours or so from those two days that  I was mentally impaired. They had assesed what the cause was: potassium deficiency. Such an innoccuous mineral could cause such a mental imbalance. 

I was quickly put on a potassium rich intravenous drip and by the morning on the third day, I waved at the Sister as she came in to the ward. An action, I can assure you, relieved her to the utmost. 

Me in the private room after my mental episode

By this time it December and it was rapidly approaching Christmas. I was determined to spend it at home and be temporarily discharged to have some time in my own environment. Working with the physios again, I had an arm gutter frame to support my weight and I had begun to stagger short distances. 

It was planned that I be discharged on the 20th of December and return for my ileostomy reversal on the 5th of January. Christmas was even more of a challenge than we dared to guess!

15 - The A to Z of wards

"..  moved wards once more.."

I was moved wards once more after the transfer between surgeons. By this time I was seriously gathering material for an A to Z reference book on both hospitals, wards and service! Having seen 6 wards and 2 hospitals already in my stay, from Critical Care, HDU, Trauma and Colorectal wards, I was meeting many people, nurses, doctors, surgeons, students and patients.

It seemed my case was something of a medical student requirement. My surgeons were refering ward students to sit with me and learn the severity of my injuries from a patient point of view. Oddly, I found great solace in retelling my story thus far to students. They would sit with me for great lengths of time, scribbling their notes and comprehending the emotional trauma I had experienced.

".. visible dye needed to be pushed into my bowel.."

The time came for me to be taken to theatres for the surgeon to remove my stomach abcesses. Prior to this, I was taken to x-ray for a detailed analysis. They needed to see exactly what they were dealing with and, to do this, visible dye needed to be pushed into my bowel and into the abcess pockets. My ilieostomy pouch was removed and a tube was inserted into it, pumping the dye through while the scan took place.

All the time I was thinking, imagining, what the driver of the other vehicle was feeling. He was lucky enough that his irresponsible driving behaviour did not injure him in any way and, within days of the collision many months before, he was probably back at work and earning his wage.

The scan completed, my operation took place. The effects of the general anaesthetic wore off and I was taken back to the ward. The hip abcesses, my surgeon advised, were too difficult to deal with at this stage, for the fistulation track apparently was intertwined over my hip bone and not easily resolved. That had to be left for the time being.

".. keeping the nurses on their toes.."

It was now a month wait until my knee was rebuilt by my Trauma and Orthopaedic consultant. During those waiting days, my sense of humour kept me sane. The ward had residing there, a rather scatty brained individual who was famed for his antics in keeping the nurses on their toes. I heard stories that, during the night, he had gotten into bed with other patients claiming they were in his bed, taken some of their possessions with a similar excuse, and found in the bathroom with his face covered in shaving cream while running his finger down his face in a shaving action. His absent mindedness was a breath of fresh air! On many occasions he walked an invisible dog around the ward and could be heard talking to it, not to leave out when he didn't want to be there anymore and simply walked out the doors. I remember one day, one of the healthcare assistants had to run down the main road outside the hospital entrance to catch him before he reached the next town!

He and I got on well, in that I was his visual reminder he had another two rooms to walk around the ward before he reached his own bed. I would be watching a DVD on a portable player when he would poke his head around the door, look at me and say, "Still another room to go!"

".. the comode, and the aroma of ... well, you get the idea"

Breakfast in a colorectal ward was an interesting challenge to. By the very nature of the ward, people had bowel issues and, those with mobility issues, had to use the comode to service a vital function. One big drawback with this was that those bodily necessities occured at mealtimes and, one such memory of mine was trying to eat breakfast, the next door bed curtain drawn around the seated patient on the comode, and the aroma of ... well, you get the idea .... drifting through the curtain while I am trying to eat but 2 feet away.

Thankfully, smells aside, my time had come to be moved to the Elective Surgery ward for my knee reconstruction. It was now November 2010, some 7 months after the collision. 

14 - Scrunch your fingers, make a 'fistula'

"..we all were determined to try to get me to my feet."

Again, I had the pleasure to meet a fantastic team of physiotherapists. These guys and gals really made improvements to my less than adequate mobility. Despite my injuries that plagued me, still including at this stage a broken leg, we all were determined to try to get me to my feet. Interspersed with being deposited into my wheelchair for the occasional trip outside to the car park to see the trees, where my leg had to be tied to the chair to stop it from dropping and causing more damage, a mechanical standing machine was utilised to help me to stand.

The trick, at this stage, was raising my bed toward the vertical as far as possible for brief periods prior to their arrival at my bedside to ensure my equilibrium was balanced. These periods, by my own determination, were ever extended to help.

The machine that helped me to my feet

".. weak with all the muscle wastage from inactivity.."

These sessions were very physically demanding for me. I couldn't put weight at all through my left leg because my knee was stll smashed, my right leg was so weak with all the muscle wastage from inactivity, which meant that I was solely dependant on pushing my weight through my arms. That would be fine if one of my elbows didn't have metal cables running across the joint (see below x-ray) which made it vastly uncomfortable to lean any weight on it whatsoever.

My progress with this was always going to be limited with a broken knee but it was rapidly brought to a halt when the domino effect that was started in the previous hospital took hold and that delicate house of cards that was my health suddenly had an earthquake.

If you recall my previous post that described the physical pain endured with the two CT (computerised tomography) and ultrasound guided drainage attempts on the internal abcesses. Access to the infected pockets was through my side and over my internal organs. My body's reactions to this trauma were to create a further multiple abcess cluster on my hip. The additional twist to this event was that the two clusters (in my stomach and on my hip) had joined themselves through a term known in the medical profession as 'collar studding'. Basically, this means that the two clusters had a tracked connection between them.

".. it can cripple mobility.."

Not only that, the hip cluster had another medical assocaiated term that was to be a major hinderence for me, a colonic 'fistula'. A definition of this term for the non medical readers out there is a connection to my large intestine. I strongly believe that this was the result of those initial attempts to drain the pockets. Anyone who has suffered an abcess will know how it can cripple mobility on their own. So for me to have two clusters in different areas of my mid section, an area vital for any sort of movement, my deliberate tries and attempts to get myself mobile from my consistently prone position.

This was not taken too well by the ward manager, who believed I should have been progressing far faster than I actually was. This over-estimation and obvious pidgeon holing I was refering to, led to a heated arguement between her and myself. She was clearly arrogant in her assessment and, because I was not making progress that fitted in with her guidelines, it must have seemed like a failing on her part to which she would have been held accountable, so she 'lashed out' at the only one who did not need that kind of stress.

These abcesses and fistula would need to be addressed in further, additional and unplanned, operations before I could progress further. I met with my colorectal surgeon, an excellent and knowledgeable individual, who agreed to transfer me to his own ward to sort them out. Before that could take place, the metal in my right leg needed to be removed as it was reacting with my skin. So, in my 17th operation, I was taken down for surgery.

13 - From hi-tech to 'third world'

"From hi-tech to third world"

The move was swift, the nurses accepted me onto the ward and, having introduced myself through a veil of tiredness, I settled into my bay of the 6 patient ward room that was to be my new environment for the next month and a half. The ambulance crew, as they wheeled me in, made, in jest, the comment associated with the title of this blog entry. The new hospital I had left, with its polished walls, patient entertainment system and impressive external vista, was suddenly a distant memory as they looked around the corridors and rooms of this older building.

For the benefit of the timeline, this move occurred 4 months after the collision and it was now August. Four months in the previous Primary Care Trust (PCT) care, including a month and a half in Critical Care in a coma, had been challenging enough but my move to the new PCT would herald a further extended stay.

"..many issues and fresh new problems"

It was here, at this new NHS PCT, that I encountered many issues and fresh new problems. Although this was a Trauma ward I was brought to, the managerial staff were not aware of my case history. It seemed that the consultant I was initially transferred to was on holiday during my move and my files were in the possession of his secretary. This caused an initial problem as the ward staff did not know the severity of my condition and, as a result, had not experienced a patient with so many orthopaedic and colorectal injuries combined as I had. As I did not fit into their pre-arranged 'pidgeon hole' for a patient, I was often overlooked and incorrect and, quite often, frustrating assumptions made about my condition.

Making friends with your ward room compatriates is a vital role for a patient with long term injuries. I saw many people come and go, their injuries not holding them back from their normal daily lives and, each time a patient in my ward room was discharged, it brought home the feelings of overwhelming solitude to me. Thoughts flashed across my mind, assumptions like, "Will I ever get out of here?", "Will I ever see our home again?" and  "Why can't I go home too?". It used to break my heart when 'friends' I had gotten to know very well in that short space of time left to return to their lives. 

"..my left leg was still damaged, my knee having been smashed.."

At this point, my left leg was still damaged, my knee having been smashed, was still needing corrective surgery and rebuilding. Although I had metalwork in my right leg, the wound on the surface was now becoming infected and needing removing. I was still bed bound and unable to walk which made things very difficult. The abcesses in my stomach were still painfully there and restricting every move, but, as I will go into later, a further complication was developing that no-one could have foreseen. My arm, again still with metal reinforcing the joint, was restrictive and uncomfortable.

"..at this time, that I saw it the worst: ... hospital food."

Let me now touch on an issue that has been covered many times before, for it was in this part of the hospital, and at this time, that I saw it the worst: ... hospital food. Now, to me, and I would hope many other people out there would agree, that a nutricious diet in a hospital environment to encourage healing and well being was a vital component of recovery. A person with so many injuries as I had, although my body found it difficult to absorb a great deal due to the physical amount of bowel that I had in operation, having a good wholesome diet of fats, proteins and carbs would be desperately important. Try telling that to a PCT financial board where the monetry cost of actually using the kitchens that exist in a hospital far exceeds the necessity of healthy patients. In my experience at this point in my recovery, the food was extremely dire.

Allow me to paint a mental picture for you. Now, this is a true story, nothing invented and no exaggerations have been emphasised in this retelling:

It was a Sunday. Part of the weekly "choose your meal for the following day" menu was a nice roast dinner; slices of beef with a Yorkshire pudding, gravy, roast potatos and green beans. The mental image of such a meal was very attractive. My opposite bed friend had ordered it the day before for just such a reason. 12:30pm rolled around and the sounds of the senior nurse ordered the healthcare assistants to rally around as the dinners had arrived on the trolleys. As our room was the final room on the ward, we had to wait for the other trays to be distributed to other patients first, but our time soon came around. My friends tray was brought in and set down on his table. I watched his face turn from a happy, expectant and hesitant face to one of surprise, shock and dismay. The corner of his mouth turned up in disgust, his nose scrunched and he translated a look of "What the f*** is this?" to me across the room. At that moment, I began lauging because he proceded to do something incredibly funny: he lifted his whole plate off the tray, with one hand, using nothing but the Yorkshire pudding as the grip. The gravy and food had congealed to the extent that his whole dinner had become an amalgam of cohesive ingredients that had fused themselves to the plate. Clearly an inedible meal!

"..tipped it 90 degrees and the food never moved."

This was one such event that highlights the issue but it wasn't isolated. Again, another dinner and another patient, this time it was a pasta meal. This friend of mine lifted his plate and tipped it 90 degrees and the food never moved.

You see, as in most hospitals now, the PCT's are outsourcing the food, staff, and other duties to external companies. The one such company that had the contract for this Trust has already been documented in a television program that covered the state of food in hospitals, a report that was not too glittering and which I saw when it was televised at a later stage (but I shall talk about that later).

"..(transported) partially cooked from the warehouse where they were made.."

The procedure, at meal times, was to transport the dinners from their conveyor belt construction, partially cooked from the warehouse where they were made which were, in this Trusts case, at least 40 miles away. On arrival to the hospital, those dinners would be unloaded, wheeled to the kitchens that were relatively unoperative and finished off in the kitchens, then kept warm until delivery to the wards. By this time, the result could only have been as I have described above.

 It had come to a point where both my wife, and the wife of one of the new patients opposite me, were bringing in additional food for the pair of us. The pannini shop for the visitors always served nice sandwiches and the Oatcake shop down the road made excellent Breakfast boxes. What really made my anger boil was that hospitals, even those newly built, all have kitchens provided but the PCT's don't seem to invest in home cooked meals, opting instead to pay external contractors to fulfil this so vital of duties. When securing the contract with the PCT's, we were told that the managers in charge had eaten items off the patient menus to agree the contracts and ensure that quality was of importance. However, either they were given exceptional meals as a one off just for the contract or they had let their quality 'slide' somewhat, complacent with the contract, but it was the patients that suffered at the expense of their financial decisions.

12 - Moving again!

".. not having much in the way of income.."

Weeks blended into months and my lengthy time at this hospital had reached its current conclusion. My wife, having been staying intermittently between the nurses station and her Aunt and Uncles house, was pleased to be moving back to a hospital near to where we live so that our cat could resume some normal living routine again and she could stay at home.

With not having much in the way of income now (statutory sick pay for me and no job for my wife having been made redundant a month prior to the accident), we had demolished our savings to stay afloat with accommodation, TV bedside 'time' purchases, magazines, food and living expenses, emergency mortgage payments and many other financial considerations that the medical professionals don't have to consider. They all do such an important job but I do feel that some consideration would be beneficial to understand things from a patients point of view.

"..the door to my room was suddenly opened.."

We had been planning to move hospitals and had put a request in to accomplish this but one day in August, the door to my room was suddenly opened by an enthusiastic military official whose position was to organise transportation of patients to alternative hospital locations. He had suddenly managed to secure a bed at our local hospital close to where we live, one in the Trauma Ward under the expert care of a Professor. The catch was, we had 2 hours to decide to go that evening to get the bed reserved and the transportation to be organised.

After a wheelchair excursion outside to ponder on all pros and cons, we decided to go for it. One of the main problems is, across the course of a hospital stay, like mine, as a patient you have a tendency to 'collect' emotional items, things to populate your "world" with, your world being your bed and immediate surroundings. Emotional ties are important, they give a long term patient a feeling of home from a distance, a ledge of safety to sit on during the cliff climb of their recovery.

".. my wife had to transport the bulk of items herself.."

The gathering of items provided us with difficulties though, for to move them all to the new hospital, my wife had to transport the bulk of items herself and with no transport but her car a 40 minute train journey away, we had a problem. That day, I think luck was shining its faded light on us for a colleague from my place of work turned up. He was able to take my wife and the bags of items to her car to continue the journey home and to the new hospital to meet me. That was at 4pm. By 6pm the ambulance crew arrived and, my notes collected from the ward reception, I was on the road in the ambulance.

An hours drive later, and in the dark, we reached my new 'home'. An old infirmary building part of a bigger complex, one of those 1940's / 1950's constructions that NHS Trusts still relied upon to provide beds and wards.  Most Trusts are investing in new hospitals these days, building new and fancy edifices that do not have the same effective patient care delivery as the older buildings. My assumption would be is that the government is taxing the NHS Trusts quite heavily for these old buildings, which although can be very attractive in their design and have many architectural features that are then lost when the Trusts have the buildings knocked over to avoid being taxed. Only my unsubstantiated assumption but it is my guess I'm not far from the truth.

11 - More days

".. intensely emotional times."

Those early months after the move were recorded by two major social events; the celebration of my birthday in late June ... and our first wedding anniversary in July. Both were intensely emotional times. I felt lucky to be alive, having almost not made my 34th birthday. My wife and I celebrated our first wedding anniversary in my hospital room with the nurses and the hospital chaplain. They even bought us a cake!

Most newly married couples celebrate their first wedding anniversary with a holiday, a break away, wining and dining with gifts and cards, picturesque scenery or hot sun. Us? We celebrated ours in a hospital ward, my room view hardly an adequate setting, with my dressings being changed as part of the routine and our evening meal one brought to me from the common daily menu.

".. those things are difficult to steer and control.."

All the lengthy physio sessions in the gym had managed to develop my right arm muscles enough to use a one arm drive wheelchair over short distances. To say that those things are difficult to steer and control is an understatement! I can only compare driving them to being as inhebriated as a student with a pocket full of free money at Happy Hour, trying to manoeuvre a supermarket trolley through a series of a tight traffic cone assault courses for a free pint of beer.  For those that do not know how one of those'demon' contraptions functions, your good arm is in charge of all the forward motion, and in turning both left and right. "How is that possible?" I hear you grumble at your screens. Well, the wheel on your good arm side has two rings around it. To go straight, you have to drive both rings at the same time, to move left its the smaller one on its own and to go right, well, you work it out!

To get into my assigned chair was a task in itself. Whenever my wife and I wanted to get some fresh air or a change of scenery, a team of three nurses / physios were required to help me into my chair in the usual method of "spin and drag" from the bed. That was, at least, the manual version. On some occassions, a mechanical hoist was utilised to 'scoop' me off the bed in a giant sling (see picture below) and deposit me into the chair.

The hoist sling!

Many times, during those days, I reached serious depression. Seeing my wife leave me every night tore me to pieces, leaving me to my thoughts with the distraction of the TV attempting to drown out my sorrows and trying to find out which nurses I knew and could rely upon during the nightshift to come to my aid if I needed it. Being unable to even get off the bed proved frustrating enough but with an ileostomy that never ceased, never stopped filling the bag at my side, needing constant emptying, I needed to be able to rely on the able staff to help me.

"..another NHS issue was noted: staffing levels."

This was where another NHS issue was noted: staffing levels. Moving to a new hospital took its toll with 'natural wastage' when ward nurses could, prior to the move, apply for different departments . So, to make up the numbers on the ward and fill the deficit, "Bank Staff" where employed. Whilst this is a good idea for general care wards with common needs, Trauma wards can have a plethora of different conditions and patient needs which did not conform to the general occupational duties.

So, in my case, I had to see who was covering the night shift so I could ask for help with my ileostomy. Not being able to get out of bed to reach the emptying bowls, gloves and cleaning materials, nor was I able to bend my arm sufficiently enough on that side to aid in its maintenence, I became somewhat reliant on trusted individuals. Having to press my nurses call alarm in plenty of time, hoping for someone to come before the seal was 'blown loose' and causing a major clean up operation. It was part of the requirement for the nurses to answer room bells within 5 minutes. However, on some occassions after pressing for assistance,a Bank Nurse would arrive after 20 minutes and merely switch off the bell, promising to return and not coming back. Again, this was a result of the design of the hospital, the layout being conceived by non-medical practitioners which made it difficult to get to all the patients, coupled with the nature of the ward dependancies.

The stress of these anxieties all added up. Being in a state of perpetual alertness during the day, by the night I was mentally tired which was made all the more difficult by having a night shift of Bank Nurses on who were not aware of / had prior experience of someone with my injuries.

10 - A developing, lasting, problem

".. undergoing frequent, daily dressing changes.."

So there I was, undergoing frequent, daily dressing changes for my laparotomy and other recently scarred wounds, when something happened out of the blue.

A hole, the size of cotton bud, opened before my, and the nurses eyes, in my stomach incision track. As if that wasn't bad enough, (make sure you have had your dinner already) copious amounts of yellowing puss began to ooze from the site. Further examination revealed a cavity under the scar, an enclosed pocket of infected 'material' that had now breached the surface of my newly forming skin.

I was scheduled for a CT scan to discern accurately what this was and how it could affect my recovery. What they found was a complication that would impair my slow, but steady, convalescence and have quite a commanding dominence that dictated a whole new schedule for delayed operations.

"..something must have been left behind, some infected material.."

To explain what they found, during my original laparotomy to add the iliostomy, something must have been left behind, some infected material, that went on to develop abcesses in my stomach. And it wasn't just one, there were three in the centre of my stomach alone, chosing to form like several Maltesers fused together. Across the course of time, these expanded their exit holes, my body clearly reacting to the infection and trying its best to evacuate the poison from where they lay.

My stomach showing the laparotomy wound and the abcess opening

To help my body along, it was decided that the abcess pockets would be drained. Whilst this sounded like a good idea, it did not succeed. The proceedure was one that I was not looking forward to at all, it was all going to be completed with local anaesthetic and with the combination of a CT scanner in that, after the local had been administered and begun working, the surgeon would make the incision in my hip and go in from the side. The tube being slowly guided inside my body cavity, by the continual scanning of the CT to obtain a relative three dimensional position of where the probe was at any one time and how far away it was from its target.

"..this was a waking torture."

Truthfully, this was a waking torture. Pain was burning my whole hip area, and the tube inside my body cavity was probing past my intestines and other organs to get to the pockets at my stomach, which had the effect of serious discomfort. In order to get through the operation I had to remain perfectly still to ensure its success. To deal with the pain that swallowed me that day, I was reduced to severe emotional turmoil that I had to let 'wash' over me. It is difficult to describe my feelings of intense rage at this situation. My thoughts were barraged with anger but I had to suppress them. It felt like frustration amplified a hundred times with lashings of acrimony tipped over me.

".. I was not only subjected to one minor, but gruelling, procedure but two.."

After what seemed like a lifetime, the procedure was over. The news from the surgeon was that the pockets beneath the one the nurses could reach, were empty, however, was not the only time this procedure was attempted for I was sent down to the Ultrasound scanning department on another occasion after the CT attempt to try again. So I was not only subjected to one minor, but gruelling, procedure but two. The wounds were still producing fluid and, although the Ultrasound procedure was moderately successful, it was still not able to help me.

Lady Luck had been on my side upt until this point but the CT procedure had started a domino fall that would evolve into further complications that I was not ready for.